Retroperitoneal Teratoma Heather Borders, MD

Size: px

Start display at page:

Download "Retroperitoneal Teratoma Heather Borders, MD"

Isaac Rodgers
6 years ago
Views:

1 Retroperitoneal Teratoma Heather Borders, MD 03/04/2012 History Newborn with congenitally diagnosed mass. No other clinical symptoms. Diagnosis Retroperitoneal Teratoma; Immature teratoma, grade 1, with microscopic yolk sac tumor. Later resection demonstrating focus of secondary neuroglial malignancy. Additional Clinical Mass continued to grow and was resected. Discussion Teratoma is a germ cell tumor that originates from pluripotent germ cells. Less than 10% of teratomas are found in the retroperitoneum. Teratoma is the third most common tumor in the retroperitoneum in children, after neuroblastoma and Wilms tumor. Teratoma is more common in females, with a bimodal age distribution (<6 months and early adulthood). Teratoma can be benign or malignant, and benign teratoma can be either mature or immature. Mature teratoma (dermoid cyst) contains well-differentiated tissues from at least two germ cell layers. Ectodermal layers are seen in all, mesodermal layers in 90% of lesions, and endodermal layers in the majority of lesions. Mature teratomas are predominantly cystic. Calcification (toothlike or well defined) and fat can be seen in 56% and 93% of cases, respectively. A fat-fluid (sebum) level and chemical shift between fat and fluid are pathognomonic. Malignancy has been reported in 2% 3% of mature teratomas, more commonly in children (26%) than adults (10%), and is associated with wall thickening, irregular margins, and infiltration of adjacent organs. Compared with mature teratoma, immature teratoma is less common (<1%), contains more than 10% undifferentiated tissue, and is seen in a younger age group (<20 years). Immature teratoma is predominantly solid, with scattered areas of fat and calcification (coarse and ill defined), but cystic components are found occasionally. Malignant teratoma can have germ cell or non germ cell malignant tissue. Malignant transformation is less common in the retroperitoneum. Malignant tumors are irregular, with invasion of adjacent structures and vascular invasion. Surgical resection is required for definitive diagnosis and treatment. Findings CT: Hypodense heterogeneous mass with scattered calcifications located in the retroperitoneum with displacement of the kidney inferiorly and encasement of multiple vessels in a similar pattern to neuroblastoma. Multiple loculations are less dense than soft tissue but not as low in density as fat. MRI done to evaluate for fat demonstrates heterogeneous signal of fluid, soft tissue and calcium but no definitive fat that suppressed on T2FS. On histology, the mass contained brown fat (which likely explains the density/signal on initial studies representing brown fat, liquid fat) and this later transformed into mature fat on the CT. Reference

2 Imaging of Uncommon Retroperitoneal Masses Prabhakar Rajiah, MBBS, MD, FRCR, et al. July 2011 RadioGraphics, 31,

7 Sponsored By Disclaimer This teaching site is partially funded by an educational grant from GE Healthcare and Advanced Radiology Services, PC. The material on this site is independently controlled by Advanced Radiology Services, PC, and GE Healthcare and Spectrum Health have no influence over the content of this site Content Download Agreement The cases and images on this website are owned by Spectrum Health. Permission is granted (for nonprofit educational purposes) to download and print materials to distribute for the purpose of facilitating the education of health professionals. The authors retain all rights to the material and users are requested to acknowledge the source of the material. Site Disclaimer This site is developed to reach healthcare professionals and medical students. Nothing this site should be considered medical advice. Only your own doctor can help you make decisions about your medical care. If you have a specific medical question or are seeking medical care, please contact your physician. The information in this website is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific medical condition. The viewpoints expressed in these cases are those of the authors. They do not represent an endorsement. In no event will Advanced Radiology Associates, PC, Spectrum Health Hospitals (Helen Devos Children's Hospital) or GE Healthcare be liable for any decision made or action taken in reliance upon the information provided through this website.

Presacral Neuroblastoma Joseph Junewick, MD FACR

Presacral Neuroblastoma Joseph Junewick, MD FACR 01/12/2010 History 16 month old male with irritability. Diagnosis Presacral Neuroblastoma Additional Clinical Initial US to evaluate for intussusception